It was a 5:30 am start for the 'brave' ones as Dr. Lieberman, Lance and I went on a four mile run on the dark and deserted roads of Mbarara. The stars were still shining, the air still and silent, save for the sound of our shoes hitting the ground and the occasional scrapes of our shoes as we try and avoid the numerous bumps and potholes... 7:00 am and we were all ready for breakfast and soon after headed over to the hospital for our first real day of work, with orthpaedic and plastic surgery cases already scheduled for 8:00 and Dr. Lieberman's spine clinic (aka “the penalty box”) scheduled for a 9:00 am start. Dr. Lieberman, Gorlick and I took some time to come up with a game plan for the day before we headed to our consult room. We were a little taken back by the multitude of patients eagerly and impatiently waiting in the hall. We were off to a slow start as patients constantly walked into the closed consult room interrupting ongoing interviews much to our dismay, but they eventually got the point after some stern instruction and the interruptions ceased. We quickly picked up the pace, seeing about 43 cases for the day, many of them follow-up cases from years past... I later on wandered into the O.R theaters and quickly got recruited by Dr. Kerner to help transport Nadine, a 28 year old burn victim who had just undergone an extensive 5 1/2 hour surgery to debride her infected wounds. After some quick planning, and the recruitment of extra hands, we transferred her into a gurney and prepared to transport her to the ICU, almost failing to notice the four new-born babies lying side by side with one’s head next to its neighbors feet. They lay in a single incubator in the corner of the room that had apparently started off empty at the beginning of the day! Nadine, the burn victim, was Dr. Kerner's second surgery patient of the day, the first being a little boy with an eyelid injury sustained from a motorcycle accident. After dropping Nadine off at the ICU, Dr Kerner discussed some post- op management and pain medication options for Denise, settling on some meperidine, as some staff hurried to purchase some morphine to assist with her longer term pain management. She quickly discussed and decided on the line-up for the next day's operations with Dr. Marvin, one of the local doctors. We headed back to the O.R and I took in a quick peek into one of the theaters as Drs. Scharschmidt, Owusu, Fisk and Lubis along with Sherri and Lance worked on their last Ortho patient of the day, intending to fix his multiple leg and foot fractures that had been sustained from a boda-boda (motorcycle taxi) accident. They settle on an external fixator (pins and bars outside the leg) for his femur after discovering a serious, extensive and non-salvageable infection within his lower leg and foot. The plan is to recommend a BKA (below the knee amputation) for the next day after having the chance to discuss it with his family. They quickly wind down; this had been their seventh case of the day, having also ran a concurrent clinic, seeing 27 patients! We slowly assemble after the rest of the groups finish off their work for the day and head back to the hotel at 9:30 pm, ordering some late dinner, then trying to curb our impatience and hunger by each reflecting on our lessons of the day- this being one of our daily rituals. A common theme for the day was the importance of resourcefulness in a setting like this, realizing that we should not take for granted all the resources that are afforded to us at the health care facilities back home and also how much can be accomplished with so little. We slowly wind down after dinner and head over to bed, ready to do it all over again the next day… QOTD: I’m here to pay for my sins- Lance at 05:27 a.m while lacing up his running shoes. Runner up QOTD: ‘Have fun in the penalty box’- Dr. Mark Kayanja’s early morning text message to Dr. Lieberman

‘There must be an easier way to get to school’

Dr. Lieberman and Emmanuel reminiscing over pictures from the 2006 mission

Drs Scharschmidt and Fisk being innovative

Dr. Owusu trying to find the spine with an extensile approach from the femur